This document discusses investigations for jaundice, including liver function tests (LFTs), CT scan, MRI scan, ERCP, and EUS. It provides detailed information on various LFTs such as aminotransferases, alkaline phosphatase, bilirubin, and GGT. It describes characteristic patterns seen in different liver diseases and notes that additional tests may include hepatitis markers, iron studies, tumor markers, and endoscopic ultrasound. Reference sources include medical textbooks and Wikipedia.

1. Investigations in
Jaundice
Dr Nikhil Bansal
J.N.M.C.,Wardha

2. Investigations
 LFT
 CT Scan
 MRI Scan
 ERCP
 EUS
 Liver Biopsy

3. Liver Function Tests
 LFT’s : What is the basis of abnormality ?
 Any other source ?
 Associated liver diseases ?
 How to investigate?

4. Aminotransferases
 AMINOTRANSFERASES :
 ASPARTATE AMINOTRANSFERASE
 (AST, formerly serum glutamic oxaloacetic
transaminase or SGOT)
 ALANINE AMINOTRANSFERASE
 (ALT, formerly serum glutamic pyruvic
transaminase or SGPT)

5. Elevation means…
 Elevation
: 2º to leakage from
damaged cells
 Occursmany forms of liver disease
but especially hepatocyte necrosis
 Eg. acute viral, chemical, ischaemia

6. ALT and AST
 ALT : relatively specific to liver
 AST :cardiac muscle, skeletal muscle,
kidney,brain, pancreas, RBC’s
 ISOLATED OR DISPROPORTIONATE
ELEVATION AST : Search for extrahepatic
sources (cardiac or physical exercise)

7. ALT and AST Levels
 Usually < 300 in patients with alcoholic
hepatitis or biliary obstruction(beware
superimposed disease)
 Although sensitive indicator hepatocellular
necrosis frequently normal in cirrhosis or
on-going disease

8. Lactate Dehydrogenase(LDH)
 Wide tissue distribution
 Elevated in skeletal, cardiac muscle, haemolysis,
stroke, renal infarction and liver disease
 Useful : ischaemia, malignant infiltration

9. ALKALINE PHOSPHATASE
 Group of enzymes (liver, bone,
intestine, kidney,placenta,
leukocytes, neoplasms)
 Increased production in tissues
metabolic stimulation Bone / liver /
intestinal

10. ALKALINE PHOSPHATASE
 Elevation of AP :Increased synthesis and release
(not impaired biliary secretion)
 May take 1-2 days to be elevated
 Half-life 1 week
 Massive ↑ infiltrative disorders biliary obstruction
(intra or extra)
 Focal obstruction with normal bilirubin

11. GAMMA GLUTAMYL
TRANSPEPTIDASE (GGT)
 - Found in many extra-hepatic tissues
 - Not found in appreciable quantities in bone
 - Helpful confirming hepatic origin of Alk. Phos.
 - 1/3 of alcohol consumers > 80g/day have normal
 GGT and does not rise during binges

12. BILIRUBIN
 Serum bilirubin normally almost entirely
unconjugated (reflects a balance between
production and excretion)
 1. Unconjugated (increased production eg
haemolysis or inherited defect in conjugation)
 2. Conjugated : reduced hepatic excretion
Prognostically useful (acute liver failure, alcohol)
Levels > 500 unusual in absence renal failure and
haemolysis

13. Other LFTs
 PROTHROMBIN
TIME
 ALBUMIN

14. CHARACTERISTIC
BIOCHEMICAL PATTERNS
 MARKED AMNOTRANSFERASE
ELEVATION
> 1000:Drugs, toxins, ischaemia,
viral,(auto-immune)
 250-1000:Any type : viral, drug,
auto-immune, Wilson’s, α1AT, Over
The Counter drugs.

15. MILD PERSISTENT
AMNOTRANSFERASE ELEVATION
 Any type : Fatty liver
 Drugs
 Alcohol
 Chronic viral hepatitis
 Neoplasms
 Haemochromatosis

16. CHOLESTATIC LFT’s
 DISPROPORTIONATE ALK PHOS
(COMPARED TO Total bilurubin)
 Partial biliary obstruction, hepatic
infiltration, infection Confirm liver origin
 DISPROPORTIONATE Total Bilurubin
(COMPARED TO ALK PHOS) : Haemolysis
or Gilbert’s Syndrome

17.  ISOLATED GGT
 Alcohol and Drugs
 ELEVATED ALK PHOS AND NORMAL GGT
 Rapid bone growth
 Bone disease
 Pregnancy

18.  OTHER LABORATORY INVESTIGATIONS
 * LFTs
 * Prothrombin
 * Hepatitis B and C markers
 * Serum caeruloplasmin (if age < 60)
 * Immunoglobulins
 * Fasting Triglycerides and cholesterol
 * HbA1c
 * Ferritin
 * Tumour markers

26. Endoscopic Ultrasound

27. References
 Harrison's principles of internal
medicine.
 Davidson’s Principles and practice of
medicine.
 www.wikipeida.com